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Stroke Outcome Related to Initial Volume Status and Diuretic Use
Christopher J Renner1, Scott E Kasner1, Philip M Bath2
1University of Pennsylvania Philadelphia PA.
Journal of the American Heart Association
|December 14, 2022
Summary
Baseline hydration status impacts stroke outcomes. Volume contracted state (VCS) and diuretic use were linked to increased mortality and poorer functional outcomes in ischemic stroke patients.
Area of Science:
- Neurology
- Nephrology
- Critical Care Medicine
Background:
- Stroke outcome is influenced by hydration status.
- Volume contracted state (VCS) and diuretic use are key hydration-related factors.
- Understanding these factors is crucial for acute ischemic stroke management.
Purpose of the Study:
- To investigate the relationship between baseline hydration status (VCS, diuretic use) and ischemic stroke outcomes.
- To determine the impact of these factors on functional recovery and mortality at 90 days.
- To identify potential targets for improving stroke patient care.
Main Methods:
- Analysis of a prospective cohort of 5971 ischemic stroke patients from the VISTA database.
- VCS defined by blood urea nitrogen-to-creatinine ratio.
- Generalized ordinal logistic regression used to assess modified Rankin Scale (mRS) at 90 days, adjusting for covariates.
Main Results:
- 42% of patients used diuretics; 44% were in VCS.
- VCS patients were older, had more risk factors, and experienced more severe strokes.
- Diuretic use was linked to worse functional outcomes (OR 0.57) and higher mortality (OR 2.30). VCS was associated with increased mortality (OR 1.53).
Conclusions:
- VCS at hospitalization correlated with stroke severity and mortality but not functional outcome after adjustments.
- Diuretic use and hypokalemia at stroke onset were associated with worse outcomes.
- Further research into hydration management in stroke is warranted.
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